Volunteer Emergency-Responder Work-Absence Notice and Verification Packet - Wyoming
VOLUNTEER EMERGENCY-RESPONSE PAID-LEAVE NOTICE AND VERIFICATION
Wyoming State officers and employees — Wyo. Stat. Ann. § 9-3-107
This packet documents Wyoming's narrow paid-leave route for qualifying volunteer emergency-response service or training.
1. STATE-PERSONNEL GATE
| Field | Entry |
|---|---|
| Officer or employee | [________________________________] |
| State agency / position | [________________________________] |
| Normal schedule | [________________________________] |
| Supervisor / HR contact | [________________________________] |
- ☐ Requester is a Wyoming State officer.
- ☐ Requester is a Wyoming State employee.
- ☐ Agency HR confirms coverage under § 9-3-107 and current implementing procedure.
This statute does not create a leave entitlement for a private employer, county, municipality, special district, or other non-State employer.
2. ROSTERED VOLUNTEER AND ORGANIZATION GATE
Qualifying Wyoming organization:
- ☐ Volunteer fire department
- ☐ Licensed ambulance service
- ☐ County search-and-rescue organization
Organization name: [________________________________]
Roster / membership identifier: [________________________________]
Roster status effective dates: [________________________________]
Organization verification contact: [________________________________]
- ☐ Officer or employee is a rostered volunteer with the selected organization.
- ☐ Organization is located and operates in the State of Wyoming.
- ☐ Ambulance-service license confirmed, if applicable: [________________________________]
3. QUALIFYING ABSENCE
Activity type:
- ☐ Volunteer emergency-response service
- ☐ Volunteer emergency-response training
Service call, incident, mission, or training program: [________________________________]
Activity location: [________________________________]
Activity period: [START DATE / TIME] through [END DATE / TIME]
Regular State work affected: [________________________________]
Description of service or training: [________________________________]
4. CALENDAR-YEAR BALANCE
| Calculation | Hours |
|---|---|
| § 9-3-107 leave used earlier this calendar year | [________] |
| Current request | [________] |
| Total after current request | [________] |
| Remaining balance | [________] |
- ☐ Total does not exceed 24 hours in the calendar year.
5. OFFICER OR EMPLOYEE NOTICE
I notify my State agency that I will be or was absent from work for the qualifying rostered-volunteer service or training identified above and request paid leave under Wyo. Stat. Ann. § 9-3-107. I certify that the information in this packet is accurate, authorize verification with the volunteer organization, and will promptly report any change in my roster status, activity, or dates.
Notice delivered on: [__/__/____]
Agency procedure / delivery method / recipient: [________________________________]
Officer or employee signature: ________________ Date: ______________
6. AGENCY REVIEW AND TIMEKEEPING
- ☐ State-officer or State-employee status confirmed.
- ☐ Rostered-volunteer status confirmed.
- ☐ Qualifying Wyoming organization confirmed.
- ☐ Service or training and affected work confirmed.
- ☐ Twenty-four-hour calendar-year balance confirmed.
- ☐ Paid leave recorded for [________] hours.
- ☐ Additional documentation requested under agency procedure: [________________________________]
- ☐ Counsel or State-agency HR review required.
| Pay and leave item | Entry |
|---|---|
| Regular work hours missed | [________] |
| Paid § 9-3-107 leave entry | [________________________________] |
| Payroll / timekeeping reference | [________________________________] |
Agency representative: ________________________ Date: ______________
Record delivered: [DATE / METHOD]
7. POST-SERVICE OR TRAINING VERIFICATION
Section 9-3-107 does not itself prescribe a verification form. Use this section only to satisfy a lawful agency documentation procedure.
I verify that [OFFICER OR EMPLOYEE] performed or attended the qualifying activity described in this packet.
| Verification item | Entry |
|---|---|
| Actual activity dates and hours | [________________________________] |
| Service, incident, mission, or training | [________________________________] |
| Roster status during activity | [________________________________] |
| Qualifying organization | [________________________________] |
Authorized organization representative: _______ Date: ______________
Printed name / title: [________________________________]
Payroll or leave correction, if any: [________________________________]
OFFICIAL SOURCES VERIFIED
About this template
- Last updated
- August 11, 2026
- Citations checked
- August 11, 2026
- Jurisdiction
- Wyoming
- Category
- Employment & HR
Legal authority
- Wyo. Stat. Ann. § 9-3-107 (paid calendar-year leave for State officers and employees serving or training as rostered volunteer emergency-response personnel)
- 2024 Wyo. Sess. Laws ch. 18, S.F. 3 (enactment; operative leave provision effective July 1, 2024)
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on August 11, 2026.
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